Under a previous contract, Health Accounting was shown to be a practical method by which patient health outcomes could be used to assess the quality of care. In this grant application, the evaluation of the reliability and validity of the central procedures of the Health Accounting method is proposed. Six clinics which have previously utilized Health Accounting methods will undertake a series of Health Accounting studies. The study subject priorities and the health outcome standards set by the clinic physicians using formal small group estimation techniques will be statistically measured for reliability and validity. The ability of the paramedical Health Accountant to accurately determine the patient's function impairment level will be measured. Finally, as an implicit part of completing the Health Accounting project through the five stages of 1) Priority Setting, 2) Initial Outcome Assessment, 3) Definitive Assessment, 4) Quality Achievement, and 5) Outcome Reassessment, the impact of Health Accounting on quality of care will be documented.